Section of Endocrinology, Yale School of Medicine and Yale-New Haven Hospital, Fitkin 106, 333 Cedar Street, New Haven, CT, 06520-8020, USA.
Diabetologia. 2017 Sep;60(9):1586-1593. doi: 10.1007/s00125-017-4336-x. Epub 2017 Aug 2.
Metformin is one of the most popular oral glucose-lowering medications, widely considered to be the optimal initial therapy for patients with type 2 diabetes mellitus. Interestingly, there still remains controversy regarding the drug's precise mechanism of action, which is thought to involve a reduction in hepatic glucose production. It is now recommended as first-line treatment in various guidelines, including that of the EASD and ADA. Its favoured status lies in its efficacy, low cost, weight neutrality and good safety profile. Other benefits have also been described, including improvements in certain lipids, inflammatory markers, and a reduction in cardiovascular events, apparently independent from the drug's glucose-lowering effect. Data have emerged questioning the previous reluctance to use this agent in those with mild to moderate chronic kidney disease. Regulations guiding its use in patients with stable, modest renal dysfunction have, as a result, become more lenient in recent years. With no long-term studies comparing it against newer glucose-lowering drugs, some of which have more robust evidence for cardioprotection, metformin's established role as 'foundation therapy' in type 2 diabetes may justifiably be challenged.
二甲双胍是最常用的口服降糖药物之一，被广泛认为是 2 型糖尿病患者的最佳初始治疗药物。有趣的是，关于该药物的确切作用机制仍存在争议，据认为其作用机制涉及减少肝葡萄糖生成。目前，它已被各种指南推荐为一线治疗药物，包括 EASD 和 ADA 指南。它之所以受到青睐，是因为它具有疗效好、成本低、体重中性和安全性好等优点。还描述了其他益处，包括某些脂质、炎症标志物的改善，以及心血管事件的减少，这显然与药物的降血糖作用无关。有数据表明，以前人们不愿意在轻度至中度慢性肾脏病患者中使用这种药物。近年来，指导该药物在稳定、轻度肾功能障碍患者中使用的规定变得更加宽松。由于没有将其与具有更强大心脏保护作用的新型降糖药物进行长期比较的研究，二甲双胍作为 2 型糖尿病“基础治疗”的既定地位可能会受到质疑。
